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by E.J. Mundell

CDC Issues Travel Warning as West Africa Ebola Outbreak Worsens

Agency also plans to send 50 more experts to the affected countries
THURSDAY, July 31, 2014 (HealthDay News) -- With the World Health Organization reporting that the death toll in the West African Ebola outbreak has risen to 729, the U.S. Centers for Disease Control and Prevention on Thursday issued a travel warning for the region.
The "Level 3 travel advisory" urges that all non-essential travel to the affected countries -- Guinea, Liberia and Sierra Leone -- be avoided.
"The bottom line is that Ebola is worsening in West Africa," CDC Director Dr. Tom Frieden told reporters in a press briefing.
He said the travel advisory will allow those countries to focus on the outbreaks without worrying about new people coming into the region, while keeping air travel open to people who are headed to the countries to provide medical aid.
He also said that the outbreak has been bad in part because these countries haven't dealt with Ebola before and weren't prepared for it.
In the meantime, putting a halt to the epidemic is "not going to be quick. It's not going to be easy. But we know what to do," Frieden said. He said that the CDC is sending 50 additional experts to the region over the next month.
In another precautionary measure, Frieden said the CDC will be assisting in efforts in the affected countries to prevent Ebola-infected people from boarding planes. If such incidents do occur, protocols will be put in place to identify sick passengers, alert those they may have come into contact with and, if necessary, quarantine people at risk.
At this point, there are no plans to screen passengers arriving in the United States from West Africa for Ebola, the CDC said. "It is important to note that Ebola is not contagious until symptoms appear, and that transmission is through direct contact of bodily fluids of an infected, symptomatic person or exposure to objects like needles that have been contaminated with infected secretions," the CDC said in a news release.
More information
For more on the Ebola virus, visit the U.S. Centers for Disease Control and Prevention ( http://www.cdc.gov/vhf/ebola/ ).
SOURCE: July 31, 2014, news conference and news release, U.S. Centers for Disease Control and Prevention
by E.J. Mundell

There's No Ebola Cure, But Early Intensive Treatment Boosts Survival

Virus launches assault on multiple organs, keeping patients hydrated is often key, experts say
THURSDAY, July 31, 2014 (HealthDay News) -- The Ebola virus currently raging in West Africa has a well-earned reputation as one of the world's most deadly illnesses. But experts stress that early and intense medical care can greatly improve a person's chances of survival.
There's no cure or vaccine for Ebola, which wreaks life-threatening havoc within the body by attacking multiple organ systems at the same time.
Instead, doctors must fall back on the basics of "good meticulous intensive care," supporting the patient and targeting treatment toward the organs that are under attack by the virus, explained Dr. Lee Norman, chief medical officer for the University of Kansas Hospital and an expert on the disease.
"You treat the things that are failing," Norman said. "If a person is dehydrated, you treat them with IV fluid support. If a person has respiratory failure, you put them on a ventilator."
Such medical care has so far helped two American aid workers currently fighting for their lives in Liberia. Each became infected with Ebola while helping stricken patients in the West African nation.
The condition of the two American patients changes day to day. Earlier this week both Dr. Kent Brantly and Nancy Writebol were reported by the Associated Press to have improved "slightly." But an update Thursday from Samaritan's Purse said that Brantly's condition has "taken a slight turn for the worse overnight," ABC News reported.
Brantly, 33, is a family physician from Texas who serves as medical director of the Samaritan's Purse treatment center in Liberia's capital city, Monrovia. Writebol is a hygienist who works for a group allied with Samaritan's Purse.
Ebola currently is raging through the West African nations of Guinea, Liberia and Sierra Leone. As of July 29, the virus had killed 729 people and infected a total 1,323, according to the World Health Organization.
The virus is particularly tough to combat because "once it gets into the human body, it attacks so many different tissues," explained Dr. Bruce Hirsch, an infectious diseases specialist at North Shore University Hospital in Manhasset, N.Y.
In contrast, most viruses tend to target one specific organ, Hirsch and Norman said. For example, influenza goes after the respiratory system.
But Ebola attacks every organ system, including the heart, lungs, brain, liver and kidneys, Norman said. The virus even attacks a person's blood, thinning it and causing Ebola's trademark bleeding from multiple orifices.
And the impact in terms of overall illness is "additive," Norman said. "Every time you add another organ system that's failing, a person's chance of survival goes down exponentially."
The human body responds to this multiple-pronged attack by initiating a massive and intense inflammatory response -- which actually adds to the damage being done, Hirsch noted.
"It's a combination of the viral destruction and the inflammation that takes place in response that's so life threatening to us," he said.
Ebola's ravages are such that even young, healthy patients, who usually can fight off most serious illnesses, have a high death rate, Hirsch said.
Pumping fluids into patients remains the best front-line treatment for Ebola, to limit the damage caused by inflammation, Hirsch explained.
Beyond that, doctors must pay close attention to the patient and be ready to treat whatever organs are on the verge of failure, Hirsch and Norman said.
It doesn't sound like much, but this basic care can dramatically enhance chances of survival.
"If you look at the overall statistics, the mortality rate is around 50 to 60 percent, but if you get out into remote areas the mortality rate increases to around 90 percent," Norman said. "I think that reflects the fact that if more care is given and care is given early, the more survival improves."
Indeed, there was a rare moment of good news from aid agency Doctors Without Borders, NBC News reported Wednesday. In its latest update on the West African outbreak, the group said it was closing its Ebola treatment center in the Guinea town of Telimele because no new cases have been reported for the past three weeks.
"During seven weeks, 21 people with the disease were admitted to the center, with an astonishing 75 percent of patients making a recovery," Doctors Without Borders said. "Without medical care, as few as 10 percent of patients could be expected to survive."
More information
For more information on the Ebola virus, visit the U.S. Centers for Disease Control and Prevention ( http://www.cdc.gov/vhf/ebola/ ).
SOURCES: Lee Norman, M.D., chief medical officer, University of Kansas Hospital, Kansas City; Bruce Hirsch, M.D., infectious diseases specialist, North Shore University Hospital, Manhasset, N.Y.; July 30, 2014, NBC News; ABC News
by E.J. Mundell

Health Tip: Choosing a Safe Summer Camp

Make an informed selection
(HealthDay News) -- Summer camp can be a great experience for kids, but parents should make sure their children will be safe.
The American Camp Association says parents should know the answers to these questions:
What is the camp's safety philosophy? Does the camp director have at least a bachelor's degree, recent in-service training and a minimum of 16 weeks' administrative experience? Are counselors properly trained in general safety and behavior management? How old are camp counselors? What is the ratio of campers to counselors? What traits does the director look for when hiring counselors? How many counselors return from year to year? How does the camp handle special needs, behavior problems and homesickness? Are references from other parents available?
by E.J. Mundell

Burnout Common Among Transplant Surgeons, Study Reveals

40 percent admit to feeling emotionally exhausted, researchers report
THURSDAY, July 31, 2014 (HealthDay News) -- Transplant surgeons often feel emotionally drained and overextended, which are red flags for burnout, a new study suggests.
Nearly half of the transplant surgeons in the study reported having a low sense of personal accomplishment and four out of 10 admitted to feeling emotionally exhausted, researchers found.
"Burnout is common in medicine, especially in high-pressure specialties like transplantation," study co-author Dr. Marwan Abouljoud, director of the Henry Ford Transplant Institute, said in a Henry Ford Health System news release.
The study involved 218 transplant surgeons; almost 87 percent were men and they ranged in age from 31 to 79.
The investigators found 46.5 percent felt a low level of personal accomplishment and 40 percent were emotionally exhausted.
Aside from emotional exhaustion, burnout is also associated with depersonalization. Surgeons suffering from burnout may feel distant from their patients. The study found, however, only 17 percent of the surgeons felt emotionally disconnected or distant from their patients.
"This combination suggests that transplant surgeons are extremely invested in and engaged with their patients, but they are frustrated by the process," study co-author Michelle Jesse, a Henry Ford senior staff psychologist, said in the news release.
The fact that transplant patients are often critically ill and may die waiting for an organ can take a toll on surgeon's feelings of personal accomplishment, the researchers noted.
The surgeons who felt disconnected from their patients and emotionally exhausted also reported having less support from their co-workers. Meanwhile, they said they faced more psychological demands and more trouble interacting with their patients.
"Difficult patient interactions -- like patients and families angry or crying while discussing end-of-life decisions -- are not uncommon for transplant surgeons," Jesse explained. "Those are hard conversations to have with patients who are sick. Our data suggests that those who are more comfortable with those conversations may be at less risk for aspects of burnout."
The researchers said they plan to investigate ways to address burnout among transplant surgeons.
"It's about creating a culture that allows them to thrive and supports them," Jesse concluded. "First we have to understand what contributes to the development of burnout, and then tailor interventions to their needs."
The findings were presented this week at the World Transplant Congress in San Francisco. Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.
More information
The American College of Surgeons has more about doctor personalities and burnout (http://bulletin.facs.org/2013/06/personalities-and-burnout/ ).
SOURCE: Henry Ford Health System, news release, July 28, 2014
by E.J. Mundell

Some Jobs Harder on the Heart Than Others, Report Finds

But having to search for work may be just as stressful, unhealthy, researchers add
THURSDAY, July 31, 2014 (HealthDay News) -- Stress at work may raise your risk of heart attack and stroke, particularly if you work in the service industry or have a blue-collar job, U.S. health officials reported Thursday.
But being unemployed might be just as unhealthy, they added.
"Workplace factors that increase risk include job stress, exposure to air pollution -- like dust and secondhand smoke -- and noise," explained lead researcher Dr. Sara Luckhaupt, from the National Institute for Occupational Safety and Health, part of the U.S. Centers for Disease Control and Prevention.
"These workers would benefit from health programs that combine reducing occupational risk factors like job stress with health promotion activities like smoking cessation," she said.
Some workers may already have other risk factors for stroke and heart attack, such as high blood pressure and cholesterol, which can be made worse by workplace stresses, Luckhaupt explained. In fact, the researchers found that 1.9 percent of workers under 55 reported a history of heart disease and stroke.
"It's probably a combination of personal and work factors," she said.
"Don't forget the job factors," Luckhaupt said. "The noise, the air pollution and job stress could be contributing to the personal risk factors, like difficulty quitting smoking."
Unemployed workers, however, weren't spared, she noted. Among unemployed people looking for work, the rate of heart attack and stroke was also high -- 2.5 percent.
"It may be that the stress of unemployment and the lack of access to health care may be contributing to their health problems," she said.
However, whether these workers have health problems because they are unemployed or if they are unemployed because of health problems isn't known, Luckhaupt said. While the report found an association between employment stress and heart health, it did not prove a cause-and-effect link.
For the study, published in the Aug 1 issue of Morbidity and Mortality Weekly Report, the researchers compiled data from the 2008-2012 National Health Interview Survey.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said, "There is increasing interest in workplace-based disease prevention, health promotion and wellness programs as a means of improving health."
As heart disease and stroke remain the leading causes of death in men and women in the United States, prevention strategies and workplace health programs are essential, he said.
"Health professionals, employers and workers should take proactive steps to improve their heart health, implement and take advantage of comprehensive workplace wellness programs and better utilize effective interventions to prevent heart disease and stroke," he said.
More information
Visit the American Heart Association (http://www.heart.org/HEARTORG/GettingHealthy/StressManagement/HowDoesStressAffectYou/Stress-and-Heart-Health_UCM_437370_Article.jsp ) for more on stress and heart health.
SOURCES: Sara Luckhaupt, M.D., Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Aug. 1, 2014, Morbidity and Mortality Weekly Report
by E.J. Mundell

J&J Pulls Hysterectomy Tool Tied to Cancer Risk From Market

Controversial device had been used for minimally invasive hysterectomies, uterine fibroid removal
THURSDAY, July 31, 2014 (HealthDay News) -- The largest maker of a surgical tool that has shown an increased risk of spreading undetected cancers in women has said it will withdraw its device from the market.
In a letter that was to be sent to all of its customers Thursday, Johnson & Johnson asked that its laparoscopic power morcellators be returned to the company, the Wall Street Journal reported.
Sales of new morcellators had been suspended in April after the U.S. Food and Drug Administration warned that doctors should not use the tool because of the potential risk of spreading cancer during minimally invasive surgeries to remove uterine fibroids, noncancerous growths on the uterus, or the uterus itself.
The morcellator used a spinning power cutter to slice uterine tissue into smaller fragments. Those fragments were then removed through small incisions in the abdomen via a tube or laparoscope.
Experts said the company's decision sends a strong message.
"The bottom line is that it looks like the [cancer] risk is much higher than we originally thought," Dr. Steven McCarus, chief of gynecological surgery at Florida Hospital Celebration Health, which was one of the chief Johnson & Johnson training sites for the morcellator device, told the WSJ. The hospital suspended its use of power morcellators after the April FDA advisory, the newspaper reported.
McCarus added that he had been part of a committee the company formed to review existing research on the increased cancer risk, and that he had advised the company that the risk was too high.
Another doctor told the WSJ that the company's decision indicates that it agrees the risk is too significant to ignore.
"What it says to me is that they are rightfully so concerned with ramifications of spreading cancer that they just don't want any part of this market," James Barter, director of gynecologic oncology research at Holy Cross Hospital in Silver Spring, Md., told the newspaper. "The message is very, very sound, very clear. The message is that it's just not worth it."
Concerns about an increased cancer risk with morcellators have been percolating since the FDA first issued its warning in April.
Earlier this month, an FDA advisory panel said there is no way to guarantee there is no risk of spreading undetected cancer to another part of a woman's body, and they recommended that women who undergo procedures that use the morcellator should sign a written consent stating they understand the potential risks. The agency isn't obliged to follow the advice or recommendations of its advisory committees, but usually does so.
The FDA has estimated that about one in 350 women undergoing a hysterectomy or fibroid removal has an unsuspected type of cancer called uterine sarcoma. About 60,000 such surgical procedures are performed every year, according to Dr. William Maisel, deputy director for science and chief scientist at the FDA's Center for Devices and Radiological Health.
A study published just last week in the Journal of the American Medical Association more clearly pinpointed the risk of spreading cancer if morcellation was used to remove the uterus in a laparoscopic hysterectomy. The researchers noted that the risk was higher for older women.
Women who already have undergone power morcellation don't need to get a cancer screening, because some of the tissue removed during the procedure would have been sent for pathologic analysis, Maisel said. If cancer had been detected, they would have been informed, he added.
"We think that most women who have undergone these procedures require routine care," he said. "If they don't have any ongoing or recurrent symptoms, they should be fine."
Women who need a hysterectomy or fibroid removal can still undergo traditional or laparoscopic surgery, just without the use of a power morcellator, Maisel said.
The FDA approved the first power morcellator for use in 1995, Maisel said.
The medical community has been aware of the risk of cancer spread during power morcellation since the devices came onto the market, Maisel said, but "the magnitude of the risk appears to be higher than what was appreciated in the clinical community."
More information
For more about uterine sarcoma, visit the U.S. National Cancer Institute (http://www.cancer.gov/cancertopics/types/uterinesarcoma ).
SOURCES: April 17, 2014, U.S. Food and Drug Administration news briefing with William Maisel, M.D., M.P.H., deputy director for science and chief scientist, Center for Devices and Radiological Health; Wall Street Journal
by E.J. Mundell

Big Jump in Doctor's Office Visits for Young Adults With Diabetes

Overall, 1 in 10 consultations in the U.S. now involves a person with the illness, CDC says
THURSDAY, July 31, 2014 (HealthDay News) -- A new report finds that by 2010, one in every 10 visits Americans made to their doctor's office involved diabetes, with the greatest rise among those aged 25 to 44.
Data from the U.S. Centers for Disease Control and Prevention found the number of office visits for patients with diabetes in this age group jumped by 34 percent between 2005 and 2010.
Almost 29 million Americans have diabetes, the CDC said, and managing the blood sugar disease costs almost $245 billion each year. Diabetes falls into two categories: Type 1, which is typically inherited and comprises about 5 percent of cases, and type 2, which is closely tied to obesity and makes up 95 percent of cases.
Overall, the new report from the CDC's National Center for Health Statistics (NCHS) found that office-based visits for diabetes patients rose by 20 percent -- from 94.4 million in 2005 to 113.3 million in 2010.
Since diabetes is linked to other conditions such as heart disease, vision trouble and stroke, many of these visits involved treatment for multiple problems, the report found.
One expert wasn't surprised.
"Eighty-seven percent of visits to physicians by patients with diabetes were made by patients with multiple chronic conditions," said Dr. Jeffrey Powell, chief of the division of endocrinology at Northern Westchester Hospital in Mt. Kisco, N.Y.
"Approximately 35 percent of visits made by patients age 45 and over were by patients with four or more chronic conditions," he added. "This means that in addition to addressing diabetes, physicians have to consider multiple other medical conditions that the patients have as well. This becomes difficult to do in one office visit."
The CDC report, published July 31 in the NCHS Data Brief, also found that treatment got more complicated as people aged.
"Five or more drugs were continued or prescribed at 60 percent of the visits by patients with diabetes age 65 and over," Powell said. "This suggests that as people with diabetes get older, they have to take multiple medications. There is a significant financial burden to patients, plus this 'polypharmacy' can increase the chance that all of the medications will not be taken exactly as prescribed."
Another expert was alarmed by the findings in the young adult age group.
The new report "demonstrates that diabetes is no longer a disease of older patients," said Dr. Alyson Myers, an endocrinologist at North Shore University Hospital in Manhasset, N.Y.
Type 2 diabetes has "become prevalent in adolescence with the ongoing obesity epidemic," she noted.
Myers also said it was "unsurprising to note that older patients have the greatest volume of visits," since they often have multiple chronic conditions. These may include high blood pressure, kidney trouble, high cholesterol levels and heart disease.
More information
Learn more about diabetes at the American Diabetes Association (http://www.diabetes.org/diabetes-basics/?loc=db-slabnav ).
SOURCES: Jeffrey Powell, M.D., chief, division of endocrinology, Northern Westchester Hospital, Mt. Kisco, N.Y.; Alyson Myers, M.D., endocrinologist, North Shore University Hospital, Manhasset, N.Y.; U.S. Centers for Disease Control and Prevention's National Center for Health Statistics, NCHS Data Brief, July 31, 2014
by E.J. Mundell

1 in 4 U.S. Kids Underestimate Their Weight, Study Finds

Kids and parents need education about healthy weight and healthful lifestyles, experts say
THURSDAY, July 31, 2014 (HealthDay News) -- Many obese and overweight kids don't see themselves that way, which makes achieving a healthy weight almost impossible, researchers report.
In a new study, 27 percent of children and teens underestimated their weight. Fewer than 3 percent overestimated it. About 25 percent of parents underestimated their child's weight and just 1 percent overestimated it, according to the study.
"Efforts to prevent childhood obesity should incorporate education for both children and parents regarding the proper identification and interpretation of actual body weight," said lead researcher Han-Yang Chen, from the department of quantitative health sciences at the University of Massachusetts Medical School in Worcester, Mass.
"Interventions for appropriate weight loss should target children directly because one of the major driving forces to lose weight comes from the child's perception of their weight," he said.
The report was published July 31 in the journal Preventing Chronic Disease.
Dr. William Muinos, director of the weight management program at Miami Children's Hospital, said, "I see weight misperception all the time."
Parents don't understand why their child is overweight or obese, he said. Parents think their child has a glandular problem or they will outgrow obesity. "That's nonsense, because obese kids are likely to stay obese," Muinos said.
Children can misperceive their weight if all the people they see are obese or overweight, he said. "If everyone you're around in your family and your social world is obese or overweight, then you are one big happy family. And you see that in our country," Muinos explained.
For the study, Chen's team used data from the 2007 to 2008 and 2009 to 2010 National Health and Nutrition Examination Survey to assess weight perceptions. The surveys included more than 2,500 kids aged 8 to 15 years.
The researchers found that the odds of trying to lose weight was nearly 10 times higher among participants who overestimated their weight than among those who perceived their weight accurately. Those who underestimated their weight were the least likely to attempt to lose weight, according to the study.
Parental misperception of weight was not associated with attempts to lose weight among children and teens who were overweight or obese, the investigators found.
Dr. David Katz, director of the Yale University Prevention Research Center, takes a broader view of the problems of weight perception.
"Above all, this study highlights the perils of a societal preoccupation with weight, rather than a focus on health and the lifestyle factors that support it," he said.
Eating well and being active are important regardless of weight because they promote health, he said. "Weight is merely one among many measures that suggest something about overall health, albeit an important one," Katz said.
The high rate of dieting among children who overestimated their weight is of real concern, he noted. "This behavioral pattern suggests impaired body image perception and vulnerability to eating disorders," Katz said.
The more common problem of underestimating weight and its effect on lowering the likelihood of weight control efforts is also concerning, he added.
"These opposing problems are really two sides of the same coin -- the fixation on weight rather than health. In general, dieting is ill advised, both for overweight children and those misperceiving their weight as high when it isn't," Katz said.
Eating well and being active are recommended for both groups and all other children, he said. "We do need to raise awareness about the importance of childhood obesity, but we need to emphasize that what really matters is health," Katz explained.
"If a devotion to healthful behaviors was the norm in our culture, and not the perception of weight, we would not talk our children into dieting they do not need, or out of weight control efforts they do need," he said.
Muinos added that parents need to be educated about the importance of healthy eating and exercise as well as the dangers of obesity.
Getting children to eat well and exercise needs to be a family effort, Muinos said. "You cannot isolate the child who is obese. The whole family has to be involved both in exercise and diet," he said.
More information
For more about childhood obesity, visit the U.S. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/obesityinchildren.html ).
SOURCES: Han-Yang Chen, M.S., department of quantitative health sciences, University of Massachusetts Medical School, Worcester, Mass.; David Katz, M.D., M.P.H., director, Yale University Prevention Research Center, New Haven, Conn.; William Muinos, M.D., director, weight management program, Miami Children's Hospital; July 31, 2014, Preventing Chronic Disease
by E.J. Mundell

Cholesterol Drugs May Speed Healing After Surgery

Statin therapy may affect inflammatory response and help wounds recover, researchers say
THURSDAY, July 31, 2014 (HealthDay News) -- Recovery time after surgery may be reduced for patients taking the cholesterol-lowering medications known as statins, according to a new study.
The study's Irish researchers suspect that the drugs may affect the body's inflammatory response, reducing the amount of time surgical patients' wounds need to heal. And that seemed to be particularly true among people who tend to have healing complications.
"Statins have become one of the most widely prescribed medications in the world. While they are typically used to manage high cholesterol levels, a number of researchers have been investigating the benefits of statins in other conditions, such as severe infections or following organ transplantation," said the study's lead author, Dr. Gerard Fitzmaurice, from Our Lady's Children's Hospital in Dublin, Ireland, in a news release from the Society for Thoracic Surgeons.
In conducting the study, the researchers analyzed existing data on statins, most of which was from lab-based studies involving animals. They found that statins reduced the amount of time needed to recover after surgery from about 19 days to 13 days, according to the study.
Statins could improve wound healing in patients who've underdone any type of procedure, including heart surgery, the researchers concluded. This could result in smaller scars, they pointed out.
"Normal wound healing involves a series of phases that ultimately leads to a scar. Many things can affect this process and it's difficult to determine exactly how statins might improve wound healing, but it would appear that they influence a number of factors in the inflammatory response," noted Fitzmaurice. "Our analysis also shows that some statins are better at it than others."
Although the overall rate of chest wound infections is low -- only about 1 percent -- faster healing times might reduce this rate even further, especially for people with slow-healing wounds due to underlying health issues, such as diabetes.
"Based on the encouraging results in the systematic review, we would recommend consideration of an appropriately conducted, randomized-controlled, double-blind clinical trial to comprehensively assess the potential role of topical statins in the promotion of postoperative wound healing," concluded Fitzmaurice.
More information
The U.S. National Institutes of Health provides more information on statins (http://www.nlm.nih.gov/medlineplus/statins.html ).
SOURCE: The Society for Thoracic Surgeons, news release, July 31, 2014
by E.J. Mundell

Civilian Life, Not Combat, May Drive Many Veterans to Drink

Returning Guardsmen need help coping with family, money and job problems, experts say
THURSDAY, July 31, 2014 (HealthDay News) -- Difficulties in civilian life, rather than war experiences, are a source of drinking problems among U.S. National Guard soldiers back at home, a new study suggests.
Setbacks such as job loss, divorce and financial problems -- all common for returning vets -- may make as many as 13 percent of vets turn to drink, researchers found.
"Exposure to combat-related traumatic events has an important effect on mental health in the short term, but what defines long-term mental health problems among Guardsmen is having to deal with a lot of daily life difficulties that arise in the aftermath of deployment when soldiers come home," said lead researcher Magdalena Cerda, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.
These difficulties don't just aggravate existing drinking problems; "they may lead to new cases of alcohol use disorder," Cerda said. "To prevent the problem of alcohol abuse in the military from growing, we need to help Guardsmen who return home to find jobs, rebuild their marriages and their families, and reintegrate into their communities."
Nearly 7 percent of Americans have drinking problems, but the rate of alcohol abuse is twice that for reserve soldiers returning from deployment, according to background information in the study.
Rachel Yehuda, a professor of psychiatry at the Icahn School of Medicine at Mt. Sinai in New York City, agreed more attention should be paid to reservists after deployment.
"We need to make sure that we support veterans through homecoming and readjustment to civilian life, because it seems like those are the stressors that might contribute to alcohol abuse," she said.
"The findings also remind us that even though our soldiers put themselves in harm's way and are exposed to multiple life-threatening events and losses during deployment, the military environment may offer a type of social support that is protective against self-damaging behaviors," Yehuda added.
For the study, published online July 31 in the American Journal of Preventive Medicine, researchers collected data on about 1,000 Ohio National Guard soldiers who had served in Iraq or Afghanistan in 2008 and 2009.
Over three years, the soldiers were interviewed three times and asked about their alcohol use. They also were asked about exposure to traumatic events, such as land mines, vehicle crashes, enemy fire and the deaths of fellow soldiers. They answered questions about their own injuries and about stressors in their lives since returning.
Among these veterans, six out of 10 had experienced combat-related trauma, 36 percent had experienced problems since returning, and 17 percent said they were sexually harassed during their most recent deployment.
In addition, 13 percent reported alcohol abuse or dependence during their first interview, 7 percent at the second interview and 5 percent during the third interview, the researchers said.
Cerda found that having at least one civilian stressor or an incident of sexual harassment during deployment increased the odds for alcohol problems among those who hadn't abused alcohol before. Combat-related events, however, were not strongly associated with alcohol problems.
Mark Kaplan, a professor of social welfare at the Luskin School of Public Affairs at the University of California, Los Angeles, said re-entering civilian life after deployment can be "quite tough."
"Perhaps we have stressed mental health problems too much and what we need more of is an emphasis on the psychosocial circumstances," he said.
Kaplan said having social workers or professionals work with military families could help veterans readjust to life back home.
"Many are not prepared for departure to combat and many are not prepared to cope once they return," he said.
More information
For more on alcohol abuse, visit the American Academy of Family Physicians (http://familydoctor.org/familydoctor/en/diseases-conditions/alcohol-abuse.html ).
SOURCES: Magdalena Cerda, Dr.P.H., assistant professor, epidemiology, Mailman School of Public Health, Columbia University, New York City; Mark Kaplan, Dr.P.H., professor, social welfare, Luskin School of Public Affairs, University of California, Los Angeles; Rachel Yehuda, Ph.D., professor, psychiatry, and director, traumatic stress studies division, Icahn School of Medicine at Mt. Sinai, New York City; July 31, 2014, American Journal of Preventive Medicine, online

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